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Introducció Two surgical techniques to determine FCER – Mesured resection technique – Balanced gap technique Landmarks – Transepicondylar axis – Anterioposterior.

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Presentation on theme: "Introducció Two surgical techniques to determine FCER – Mesured resection technique – Balanced gap technique Landmarks – Transepicondylar axis – Anterioposterior."— Presentation transcript:

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2 Introducció Two surgical techniques to determine FCER – Mesured resection technique – Balanced gap technique Landmarks – Transepicondylar axis – Anterioposterior line – Posterior condylar line

3 Introduction Mesured resection technique – Trapezoidal flexion gap – Regardless of ligament tension Balanced gap technique – Cut parallel to the proximal tibial cutting – Better flexion stability – Better patellar tracking – Depends on soft tissue balance – Could lead to undesirable implantation

4 Purposes Determine femoral component rotations and laxities using a navigation system during CR TKA using balanced gap technique Evaluate the effects of femoral rotation on knee function

5 Materials and Methods Prospective study 47 patients Exclusion criteria: – Open knee surgery – Severe deformity (>20º varus or >30º flexion) – Other than osteoarthritis Follow-up 54,5 months (48-68) 4 men and 40 women Mean age 68,8 years (56-79)

6 Surgical Technique Medial parapatellar approach (Patellar eversion) OrthoPilot navigation system Proximal tibial cutting 0º PCL was preserved Tensioning device for extension gap Release medial structures if necessary 4-in-1 cutting block parallel to the tibial resection plane External rotation range 0-7º (Patellar tracking)

7 Surgical technique Not allowed internal rotation ER >7º release anterior fiber of SMCL Cemented Aesculap TKA Patella was not resurfaced Posterior slope 3º

8 Materials and Methods Clinical outcomes – Same physician assistant (not involved) – HSS, WOMAC, Rmotion, FT angles, Posterior femoral condyles offset, radiolucent lines – 3 and 12 months and annually Statistics – Paired Student t test – Pearson regression analysis – SPSS – Distributions were normal

9 Results Mean ER femoral component 3,8 +/-2,4º Mean knee mechanical alignments: – 0º flexion: 0,6 +/-1,1º of varus – 90º flexion: 1,4 +/-2,6º of varus Positive correlation (r:0,70 p<0,01) between FCER and varus alignment at 90º flexion 8/14 with >6º ER: more than 3º varus 2/30 with 0-5º ER: more than 3º varus 90º

10 Results Mean vr-vl laxity greater at 90º – 90º: 5,8 +/-1,9º – 0º: 4,4 +/-1,4º HSS and WOMAC improved FT angles improved Radiolucent lines 9/47

11 Discussion BG technique good alignments and stability More FCER, more varus knee at 90º flexion No correlation between FCER and preoperative mechanical angle Hanada et al: Substantial varus alignment at 90º flexion – Cadaver without soft tissue release – Did not set femoral external rotation

12 Discussion Limitations – Intraoperative laxity testing manually – Alignment was measured under non-weight- bearing conditions Conclusion – Excessive FCER can be avoided by additional soft tissue balancing, and prevents varus malalignment


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